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F. *For each BMP below, indicate the total number within your MS4, how many of each BMP type <br />were inspected and the percent inspected during the reporting period. Enter"O" if your MS4 <br />does not contain BMPs or none were inspected. Enter "NA" if the data does not exist- <br />Structure/Facility type <br />*Total number <br />*Number inspected <br />*Percentage <br />*Outfalls to receiving waters: <br />33 <br />33 <br />100 <br />*Sediment basinstponds: <br />94 <br />24 <br />25 <br />*Total <br />127 <br />57 <br />45 <br />G. Of the BMPs inspected in F.. above, did you include any privately owned BMPs in that number? El Yes N No <br />H. If yes in G.. above, how many: <br />Section 7: Impaired Waters Review (*Required fields) <br />The permit requires any permittee whose MS4 discharges to a Water of the State, which appears on the current U. S. <br />Environmental Protection Agency (EPA) approved list of impaired waters under Section 303(d) of the Clean Water Act, review <br />whether changes to the SWPPP may be warranted to reduce the impact of your discharge [Part IV.D]. <br />A. *Does your MS4 discharge to any waters listed as impaired on the state 303 (d) list? Z Yes [3 No <br />B. *Have you modified your SWPPP in response to an approved Total Maximum Daily Load (TMDL)? D Yes 0 No <br />If yes, indicate for which TMDL: <br />Section 8: Additional SWPPP Issues (*Required fields) <br />A. *Did you make a change to any BMPs or measurable goals in your SWPPP since your fast ❑ Yes 99 No <br />report? [Part VI.D.3.] <br />B, If yes, briefly list the BMPs or any measurable goals using their unique SWPPP identification <br />numbers that were modified in your SWPPP, and why they were modified: (Attach a separate <br />sheet if necessary) <br />C. *Did you rely on any other entities (MS4 permittees, consultants, or contractors) to implement 0 Yes El No <br />any portion of your SWPPP? (Part VLDA,j <br />If yes, please identify them and list activities they assisted with: <br />Rice Creek Watershed district <br />Owner or Operator Certification (*Required fields) <br />The person with overall administrative responsibility for SWPPP implementation and permit compliance must certify this M84 <br />Annual Report. This person must be duly authorized and should be either a principal executive (i.e., Director of Public Works, City <br />Administrator) or ranking elected official (i.e., Mayor, Township Supervisor). <br />*Yes - I certify under penalty of law that this document and all attachments were prepared under my direction or <br />supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the <br />information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly <br />responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, <br />accurate, and complete (Minn. R. 7001. 0070). /am aware that there are significant penalties for submitting false <br />information, including the possibility of fine and imprisonment (Minn. R. 7001-0540). <br />*Name of certifying official: Paul Palzer <br />-Title: Public Works Director *Date: <br />so= (mralddlyyyy) <br />www.pca.state.mn.us * 651-296-6300 - 800-657.3864 - TTY 651-282-5332 or 800-657.3864 - Available in attemative formats <br />wq-strm4-06 - 12119113 Page 5 of 5 <br />-6- <br />